scholarly journals Tardive dyskinesia on clozapine: A case report

2009 ◽  
Vol 15 (1) ◽  
pp. 2
Author(s):  
Laila Asmal
Keyword(s):  
South Africa ◽  
Case Report ◽  
Tardive Dyskinesia ◽  
Treatment Option ◽  
First Generation ◽  
Second Generation ◽  
Clozapine Treatment ◽  
First Case ◽  
Second Generation Antipsychotic

Antipsychotic-induced tardive dyskinesia is a potentially irremediable and debilitating condition with the onset most commonly associated with the use of first-generation antipsychotics. The development of tardive dyskinesia on clozapine, a second-generation antipsychotic, is uncommon, and the drug is therefore a treatment option for those patients who develop the syndrome following treatment with first- generation agents. I report on the case of a 27-year-old man who developed severe tardive dyskinesia following initiation of clozapine treatment. To the best of my knowledge, this is the first case of tardive dyskinesia associated with clozapine use reported in South Africa.

scholarly journals Epidemiologic characteristics of early cases with 2019 novel coronavirus (2019-nCoV) disease in Korea

2020 ◽  
Vol 42 ◽  
pp. e2020007 ◽  
Author(s):  
Moran Ki
Keyword(s):  
First Generation ◽  
Second Generation ◽  
Additional Data ◽  
Reproduction Number ◽  
First Case ◽  
Novel Coronavirus ◽  
Epidemiologic Characteristics ◽  
Index Cases ◽  
Epidemiological Information ◽  
Close Contacts

In about 20 days since the diagnosis of the first case of the 2019 novel coronavirus (2019-nCoV) in Korea on January 20, 2020, 28 cases have been confirmed. Fifteen patients (53.6%) of them were male and median age of was 42 years (range, 20-73). Of the confirmed cases, 16, 9, and 3 were index (57.2%), first-generation (32.1%), and second-generation (10.7%) cases, respectively. All first-generation and second-generation patients were family members or intimate acquaintances of the index cases with close contacts. Fifteen among 16 index patients had entered Korea from January 19 to 24, 2020 while 1 patient had entered Korea on January 31, 2020. The average incubation period was 3.9 days (median, 3.0), and the reproduction number was estimated as 0.48. Three of the confirmed patients were asymptomatic when they were diagnosed. Epidemiological indicators will be revised with the availability of additional data in the future. Sharing epidemiological information among researchers worldwide is essential for efficient preparation and response in tackling this new infectious disease.

The Metabolic Impact of the Antipsychotic Drugs in Patients with Bipolar Disorder

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
M. Tournier ◽  
A. Cougnard ◽  
B. Bégaud ◽  
A. Thiébaut ◽  
H. Verdoux
Keyword(s):  
Bipolar Disorder ◽  
First Generation ◽  
Second Generation ◽  
Mood Stabilizer ◽  
Care Program ◽  
Mood Stabilizers ◽  
Lipid Lowering ◽  
Study Population ◽  
Second Generation Antipsychotic ◽  
Lowering Drug

Objective:To assess the metabolic impact of adding an antipsychotic to a mood stabilizer or switching a mood stabilizer to an antipsychotic in patients with bipolar disorder.Methods:A retrospective fixed cohort study was conducted through the claims database of the French health care program for the self-employed workers. The study population consisted of 3.172 patients age 18 and over who were exposed to mood stabilizers (i.e. lithium, valproate) a 3 month-period in 2004 without dispensing of non-sedative antipsychotic, antidiabetic or lipid-lowering drugs. The outcome was the occurrence of a metabolic incident over the follow-up period, using the dispensing of an antidiabetic drug as a marker of diabetes and the dispensing of a lipid-lowering drug as a marker of hypercholesterolemia or hypertriglyceridemia. A Cox proportional hazard model was used to assess the metabolic impact of the antipsychotics; using mood stabilizers as a reference. Antipsychotic exposition was stratified in «current» and «recent» (discontinued for less than 6 months) at the time of the metabolic incident.Results:196 patients (6.2%) received a first-generation antipsychotic, 352 (11.1%) a second-generation antipsychotic, 565 (17.8%) a sedative antipsychotic and 367 patients (11.6%) presented with a metabolic incident over the study period. The recent dispensing of a second-generation antipsychotic was associated with the occurrence of a metabolic incident [HR 2.1 (95%CI 1.2-3.7) p=0.006], while current dispensing or dispensing of first-generation antipsychotics were not.Conclusion:Second-generation antipsychotics have a metabolic impact compared to classic mood stabilizers in patients with bipolar disorder.

Antipsychotic utilisation and persistence in Australia: A nationwide 5-year study

2021 ◽  
pp. 000486742110516
Author(s):  
Mark Taylor ◽  
Dante Dangelo-Kemp ◽  
Dennis Liu ◽  
Steve Kisely ◽  
Simon Graham ◽  
...  
Keyword(s):  
First Generation ◽  
Second Generation ◽  
Treatment Persistence ◽  
Persistence Time ◽  
Hazard Ratios ◽  
Second Generation Antipsychotics ◽  
Time In Treatment ◽  
Second Generation Antipsychotic ◽  
Long Acting ◽  
Subsequent Relapse

Objectives: To evaluate the utilisation and persistence of antipsychotics for the treatment of schizophrenia in Australia. Methods: A retrospective study using the Australian Pharmaceutical Benefits Scheme database of a representative 10% sample. All adults with schizophrenia who were dispensed three or more supplies of oral (including clozapine) or long-acting injectable antipsychotics between 1 June 2015 and 31 May 2020 were included. Persistence time in treatment was evaluated using survival analysis and Cox hazard ratios. Results: In all, 26,847 adults with schizophrenia were studied. Oral second-generation antipsychotics were more frequently dispensed than the other antipsychotic groups studied. Median treatment persistence times were 18.3 months for second-generation antipsychotic long-acting injectables, 10.7 months for oral second-generation antipsychotics and were significantly lower for both formulations of first-generation antipsychotics at 5.2 months (long-acting injectables) and 3.7 months (oral). The median persistence time for clozapine was significantly longer than all other antipsychotics groups. Conclusions: Oral second-generation antipsychotics and second-generation antipsychotic long-acting injectables accounted for over 75% and 13% of all antipsychotics in Australia, respectively. Concerns over medication adherence and subsequent relapse have not translated into increased long-acting injectable usage despite their significantly longer persistence. Clozapine, the single most ‘persistent’ antipsychotic, was only used in 9% of people, although up to a third of all cases are likely to be treatment-resistant. Our data suggest clinicians should give consideration to the earlier use of second-generation antipsychotic long-acting injectables and clozapine, to ameliorate prognosis in schizophrenia.

Differential Impairments in Incentive Learning Caused by First‐ and Second‐ Generation Antipsychotic Drugs

2016 ◽  
Author(s):  
Matthew Florczynski
Keyword(s):  
Neural Control ◽  
First Generation ◽  
Antipsychotic Drugs ◽  
Second Generation ◽  
Operant Chamber ◽  
Incentive Learning ◽  
Dopamine Receptor Antagonists ◽  
Natural Response ◽  
Second Generation Antipsychotic ◽  
First And Second Generation

Schizophrenia is a neuropsychiatric disorder characterized by increased function of dopamine in the brain.  Dopamine release is a natural response to reward.  It promotes incentive learning (IL), a process by which neutral stimuli acquire the ability to elicit approach and other responses.  A recent model characterizes dopamine‐mediated IL as a progressive process with early and late stages accompanied by a shift in neural control from the nucleus accumbens (NAc) to the dorsolateral striatum (DLS).  A parallel can be drawn to differences in regionally specific neural responses generated by first‐ and second‐generation antipsychotic drugs (APDs) used to treat schizophrenia.  APDs are dopamine receptor antagonists, but first‐generation APDs affect the NAc and DLS while second‐generation APDs affect primarily the NAc.  We compared the effects of APDs on IL. Rats (N = 48) were trained to press a lever forfood pellets in an operant chamber.  Intraperitoneal injections (1 hr before testing) of the first‐generation APD haloperidol (0,0.05,0.10,0.20 mg/kg) or of the second‐generation APD risperidone (0,0.20,0.40,0.80 mg/kg) induced dose‐dependent suppression of lever pressing on days 1‐4, with the highest dose groups failing to demonstrate any evidence of previous learning on day 5 when tested drug‐free.  On days 16‐20 haloperidol induced a day‐to‐day suppression not seen with risperidone.  The results suggest that the effects of first‐ and second‐generation APDs on learning processes putatively mediated by the NAc and DLS can be differentiated experimentally.  The findings imply that APDs may differentially affect IL inpatients with schizophrenia.  

4.  Differential Impairments in Incentive Learning Caused by First‐ and Second‐ Generation Antipsychotic Drugs

2016 ◽  
Author(s):  
Matthew Florczynski
Keyword(s):  
Neural Control ◽  
First Generation ◽  
Antipsychotic Drugs ◽  
Second Generation ◽  
Operant Chamber ◽  
Incentive Learning ◽  
Dopamine Receptor Antagonists ◽  
Natural Response ◽  
Second Generation Antipsychotic ◽  
First And Second Generation

Schizophrenia is a neuropsychiatric disorder characterized by increased function of dopamine in the brain.  Dopamine release is a natural response to reward.  It promotes incentive learning (IL), a process by which neutral stimuli acquire the ability to elicit approach and other responses.  A recent model characterizes dopamine‐mediated IL as a progressive process with early and late stages accompanied by a shift in neural control from the nucleus accumbens (NAc) to the dorsolateral striatum (DLS).  A parallel can be drawn to differences in regionally specific neural responses generated by first‐ and second‐generation antipsychotic drugs (APDs) used to treat schizophrenia.  APDs are dopamine receptor antagonists, but first‐generation APDs affect the NAc and DLS while second‐generation APDs affect primarily the NAc.  We compared the effects of APDs on IL. Rats (N = 48) were trained to press a lever for food pellets in an operant chamber.  Intraperitoneal injections (1 hr before testing) of the first‐generation APD haloperidol (0,0.05,0.10,0.20 mg/kg) or of the second‐generation APD risperidone (0,0.20,0.40,0.80 mg/kg) induced dose‐dependent suppression of lever pressing on days 1‐4, with the highest dose groups failing to demonstrate any evidence of previous learning on day 5 when tested drug‐free.  On days 16‐20, haloperidol induced a day‐to‐day suppression not seen with risperidone.  The results suggest that the effects of first‐ and second‐generation APDs on learning processes putatively mediated by the NAc and DLS can be differentiated experimentally.  The findings imply that APDs may differentially affect IL inpatients with schizophrenia.

Mechanisms of action of second generation antipsychotic drugs in schizophrenia: insights from brain imaging studies

2005 ◽  
Vol 20 (1) ◽  
pp. 15-27 ◽  
Author(s):  
Anissa Abi-Dargham ◽  
Marc Laruelle
Keyword(s):  
First Generation ◽  
Antipsychotic Drugs ◽  
Second Generation ◽  
Dopaminergic System ◽  
Therapeutic Strategies ◽  
Therapeutic Action ◽  
Imaging Studies ◽  
High Incidence ◽  
Second Generation Antipsychotic ◽  
Clinically Significant

AbstractMultiple lines of evidence including recent imaging studies suggest that schizophrenia is associated with an imbalance of the dopaminergic system, entailing hyperstimulation of striatal dopamine (DA) D2 receptors and understimulation of cortical DA D1 receptors. This DA endophenotype presumably emerges from the background of a more general synaptic dysconnectivity, involving alterations in N-methyl-d-aspartate (NMDA) and glutamatergic (GLU) functions. Equally important is the fact that this DA dysregulation might further impair NMDA transmission. The first generation antipsychotic (FGA) drugs are characterized by high affinity to and generally high occupancy of D2 receptors. The efficacy of FGAs is limited by a high incidence of extrapyramidal side-effects (EPS). Second generation antipsychotic (SGA) drugs display reduced EPS liability and modest but clinically significant enhanced therapeutic efficacy. Compared to FGAs, the improved therapeutic action of SGAs probably derives from a more moderate D2 receptor blockade. We will review the effects of SGAs on other neurotransmitter systems and conclude by highlighting the importance of therapeutic strategies aimed at directly increasing prefrontal DA, D1 receptor transmission or NMDA transmission to enhance the therapeutic effect of moderate D2 receptor antagonism.

Variation in Australian and Some Overseas Populations of Emex australis and E. spinosa

1979 ◽  
Vol 27 (5) ◽  
pp. 631 ◽  
Author(s):  
PW Weiss ◽  
DM Simmons
Keyword(s):  
South Africa ◽  
Western Australia ◽  
First Generation ◽  
Second Generation ◽  
Emex Australis ◽  
Hierarchical Grouping ◽  
Two Generations

Australian populations of the widespread Emex australis and the more restricted E. spinosa were tested for subspecific variation. The plants were grown for two generations in a glasshouse from seed collected from field populations. The results from growing the first generation showed that two groupings of E. australis could be made on the basis of hierarchical grouping analysis, but the populations were much more similar in the second generation and such groupings could not be made. There were no marked differences between E. australis populations from Australia and South Africa, although one from Hawaii was less vigorous than the others. Amongst Australian populations of E. spinosa, one from Western Australia was less vigorous than the others. It was also found that Australian populations of E. spinosa were generally similar to those from Portugal and slightly more vigorous than those from Morocco.

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